On Hospitalization
Content warning: suicide, inpatient hospitalization
Some of you who are reading have been hospitalized before with suicidal ideation, a manic episode, or other critical mental health symptoms. (I'm glad you are here. I hope you have experienced healing since that time.) Some of you who are reading have never been hospitalized and never had to think about it. And some of you who are reading are currently considering hospitalization. Regardless of your past or current experience, this is a complicated topic, and I'd like to cover it as I hope it will be helpful.
Potential benefits of hospitalization:
You are (probably) going to get the care you need. If you have not previously been in groups, if you have not previously been in therapy or learned coping skills, this may be your chance to plug into services that can benefit you in the long-term.
If your medications need to be reexamined (or if you are not currently on medications), this is an opportunity to have adjustments or new medications started in a setting where your reactions can be monitored. Typically medications can be monitored effectively in an outpatient setting, and please refer to your physician for their recommendations as medication and prescribing is absolutely not in my wheelhouse as a non-prescriber.
There is solace in routine and respite from stressful others. Sometimes hospitalization can be a needed break and a chance to engage in self-care. (Beware—as this may be reinforcing and may encourage you to go back to the hospital in the future.)
At the same time, people experience valid hesitation about going to the hospital, given factors related to cost, disruption of daily life, and lack of control within an inpatient setting. I want to emphasize that if you are reading this and truly believe you will not be able to stay safe, if you are not able to call a friend or engage in safety planning, hospitalization is likely your best option.
I only hospitalize my clients as a last resort—in instances where the person's life is in danger, definitely, right now, today, and the person will not agree to a safety plan with me. The reasons I typically do not push hospitalization except in rare instances of crisis are the same reasons that DBT generally recommends against hospitalization:
The hard work is still waiting for you when you leave the hospital. Hospitalization typically will not change the stressors in your life.
An adherent DBT program is standard of care for intense suicidality already.
Hospitalization can at times be reinforcing as it can unintentionally serve as a respite from stressors of daily life (conflict at home, studies, job, other responsibilities)
Hospitalization interrupts parts of life essential for building mastery, living towards values, and creating a life worth living (schooling, career, family relationships).
Steps I usually recommend before sending someone to the hospital:
Creating a written safety plan with numbers of loved ones to call, ways to distract from urges, and ways to minimize vulnerability, then adhering to that plan.
Removing access to lethal means (for example, giving extra medications to a trusted person or having a lockbox in the home that only a loved one has access to). This may mean creating a pillbox for existing medications rather than having full bottles available. It may mean locking away dangerous items.
Check in phone calls daily to reevaluate suicide risk and having an infrastructure for the client to make calls to get skills to manage crisis urges (skills line).
Increasing session frequency with their therapist or considering an intensive outpatient (IOP) or PHP (partial hospitalization program). These programs allow for many hours of therapy time per week without entirely uprooting a person from their environment.
As you can see, we do have some wiggle room and some ways to dial up care and ensure safety without residential hospitalization. If you are concerned about your safety, here are some helpful resources:
911
National Suicide Prevention Lifeline: 1-800-273-8255
National Crisis Text Line: text “HOME” to 741741
If you're in Mecklenburg County (Charlotte, NC) you can call Mecklenburg Mobile Crisis at 704-566-3410.
If you are safe for today, and you feel it's time to seek therapy so you can stay safe for the long-term, feel free to touch base and book an appointment by clicking the button below. I offer therapy in Huntersville, NC, and online therapy in NC and SC. Thank you for the time you invested reading this.
